Dynamic stimulation adjustment for identification of a neural fulcrum
First Claim
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1. A neurostimulation system, comprising:
- an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient, said stimulation signal comprising an ON time and an OFF time; and
a control system programmed to;
monitor a heart rate of a patient implanted with the IMD during delivery to the patient of a plurality of stimulation signals at a first frequency, each stimulation signal having at least one parameter setting different than the parameter settings of the other stimulation signals in the plurality of stimulation signals, wherein said monitoring the heart rate comprises monitoring a baseline heart rate during the OFF time periods of the stimulation signal and monitoring a heart rate response during the ON time periods of the stimulation signal;
identify a first subset of the plurality of stimulation signals during which tachycardia is detected during the ON time periods of the stimulation signal;
identify a second subset of the plurality of stimulation signals during which bradycardia is detected during the ON time periods of the stimulation signal; and
identify a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is detected during the ON time periods of the stimulation signal, said transition heart rate response between tachycardia and bradycardia and comprising a heart rate change from the baseline heart rate of less than 5%.
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Abstract
Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A computer-implemented control system is operated to automatically identify a neural fulcrum zone based on a monitored patient physiological response. Ongoing neurostimulation therapy is delivered within the neural fulcrum zone.
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Citations
21 Claims
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1. A neurostimulation system, comprising:
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an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal to a patient, said stimulation signal comprising an ON time and an OFF time; and a control system programmed to; monitor a heart rate of a patient implanted with the IMD during delivery to the patient of a plurality of stimulation signals at a first frequency, each stimulation signal having at least one parameter setting different than the parameter settings of the other stimulation signals in the plurality of stimulation signals, wherein said monitoring the heart rate comprises monitoring a baseline heart rate during the OFF time periods of the stimulation signal and monitoring a heart rate response during the ON time periods of the stimulation signal; identify a first subset of the plurality of stimulation signals during which tachycardia is detected during the ON time periods of the stimulation signal; identify a second subset of the plurality of stimulation signals during which bradycardia is detected during the ON time periods of the stimulation signal; and identify a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which a transition heart rate response is detected during the ON time periods of the stimulation signal, said transition heart rate response between tachycardia and bradycardia and comprising a heart rate change from the baseline heart rate of less than 5%. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method of operating an implantable medical device (IMD) comprising a neurostimulator coupled to an electrode assembly, said neurostimulator adapted to deliver a stimulation signal comprising an ON time and an OFF time, said method comprising:
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operating a control system to activate the IMD to deliver to the patient a plurality of stimulation signals at a first frequency, each stimulation signal having at least one parameter setting different than the parameter settings of the other stimulation signals in the plurality of stimulation signals; monitoring a baseline heart rate during the OFF time periods of the stimulation signal; monitoring a heart rate response during the ON time periods of the stimulation signal; detecting with said control system tachycardia during a first subset of the plurality of stimulation signals and bradycardia during a second subset of the plurality of stimulation signals; and operating the control system to identify a neural fulcrum zone corresponding to a third subset of the plurality of stimulation signals during which the control system detects a transition heart rate response, said transition heart rate response being between tachycardia and bradycardia and comprising a heart rate change from the baseline heart rate of less than 5%. - View Dependent Claims (19, 20, 21)
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Specification